PubMed · 10210010
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D Gray. 1999-04-03. Allergen-specific T-cell memory.. https://doi.org/10.1016/s0140-6736(05)74410-x
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A few groups have endured the challenges of time, anecdotal success stories, logistic and funding impediments, to bring the field of clinical islet transplantation where it stands today. The recent improvement in clinical results has paralleled a renewed interest in islet transplantation and an increasing number of centers have entered the field. Selected institutions have now clearly demonstrated that insulin independence can be a reproducible and achievable goal. Other centers struggle with mixed results, while occasional early failures of islet transplants are still observed. This center effect underlines not just a learning curve, but also the complexity of the approach, which requires multidisciplinary expertise and attention to critical variables that need to be closely monitored to assure adequate clinical outcomes. The future success and large scale applicability of islet transplantation will rely on the synergistic research progress in critical areas that contribute to the sequential and integrated approach required for success in clinical islet transplantation.
For islet transplants to complete the transition from clinical research to clinical care restoration of insulin independence must be achieved--as with pancreas transplants--with a single donor. To achieve this critical milestone more consistently it will be imperative to pursue the following complementary strategies simultaneously: 1) enhancing the metabolic potency, inflammatory resilience, and immune stealth of isolated islets; 2) inhibiting the thrombotic and inflammatory responses to transplanted islets; and 3) achieving immune protection with strategies lacking diabetogenic side effects. Maintaining insulin independence will be a different challenge requiring us to clarify whether failure of initially successful islet allografts in type 1 diabetes is related: to 1) failure of immunosuppressive regimens to control alloimmunity and autoimmunity; 2) failure of islet regeneration in the presence of currently applied immunosuppressive regimens; and/or 3) failure of islet neogenesis in the absence of an adequate mass and viability of co-transplanted/engrafted islet precursor cells.
Sikkim and Darjeeling Himalayan region is characterized by a rich floral diversity and an equally rich ethnomedicinal tradition. Herbal medicine is the dominant system of medicine practiced by the local tribes of this region for the treatment of diabetes. During the course of the present studies it was found that 37 species of plants belonging to 28 families are used as antidiabetic agents in the folk medicinal practices in the region and 81% of these plants are hitherto unreported as hypoglycemic agents. This finding may lead to serious research towards developing new and efficient drugs for diabetes.